Changing disease pattern of patients attending a geriatric clinic in India

Background: Psychiatric morbidity is common in geriatric population along with other medical ailments. Increasing longevity contributes to higher prevalence of degenerative diseases in the elderly. In this perspective, the disease patterns may have changed in this age group and more so in the developing countries. Objectives: The current study explores the sociodemographic profile, disease patterns of various psychiatric ICD-10 diagnoses, and medical comorbidities in the elderly outpatients attending geriatric clinic. Materials and Method: The sample consists of 319 elderly outpatients attending geriatric clinic from September 1999 to December 2002 at National Institute of Mental Health and Neuro-Sciences, Bengaluru, India. This institute is one of the 10/66 centers. This sample is a heterogeneous population of both genders and age >60 years. The patients were assessed using a semi-structured interview as well as laboratory and other investigations as required. Results: The common psychiatric morbidity of this population is dementia (42.4%) and affective disorders (27.3%). However, the medical comorbidity of these patients is also high (41.9%). Previous study from the same center in 1996 reported that 4.2% of patients attending psychiatric services were 60 years and above. The most common problems in the previous study included psychoses (66%), of which about two-thirds (43% of the total) were non-organic psychoses. Conclusion: Dementia, a degenerative disease, forms the largest group of mental illness in elderly outpatients attending geriatric clinic. Other organic psychiatric diseases follow this. Medical comorbidity is concurrently seen in patients with the psychiatric morbidity. This extrapolates the requirement of the multidisciplinary approach in managing the patients in geriatric age group.

Antimicrobial drug resistance in escherichia coli isolated from commercial chicken eggs in Grenada, West Indies / Resistencia antimicrobiana a los medicamentos en escherichia coli aislada de huevos comerciales de gallina en Granada, West Indies

OBJECTIVE: To determine the antimicrobial resistance profile of Escherichia coli (E coli) isolated from the shell membrane and yolk of commercial chicken eggs in Grenada. METHODS: A total of 450 eggs were collected from different locations including small (33.3%) and big farms (26.7%), roadside vendors (26.7%) and supermarkets (13.3%). The shell membranes and yolk were cultured separately on blood agar and McConkey Agar. Escherichia coli were identified using biochemical tests and API20E strips. The isolates were tested for antimicrobial sensitivity. RESULTS: A total of 55 E coli isolates were obtained. Of which 34 isolates were from shell membrane and 21 from yolk samples. Twenty-two of the total 34 isolates from shell membrane exhibited resistance to one or more ofthe antibiotics used in the study whereas 11 of the 21 yolks isolate also showed resistance to one or more ofthe tested antibiotics. Among the six antibiotics tested, the highest level of resistance was observed for ampicillin, 42.9 per cent and 31.8 per cent respectively for shell membrane and yolk isolates. The lowest resistance rate among all the antibiotics was observed against enrofloxacin (0%). Multi-drug resistance (resistance to > 3 compounds) was observed in 10.9% of the isolates. CONCLUSIONS: This study on E coli drug resistance in commercial chicken eggs in Grenada generated baseline data indicating that chicken eggs used for food can harbour resistant E coli. A regular monitoring ofcommensal and clinical isolates of E coli for antibacterial resistance is warranted.

OBJETIVO: Determinar el perfil de resistencia antimicrobiana de Escherichia coli (E coli) aislada de la membrana de la cáscara y la yema de huevos comerciales de gallinas en Granada. MÉTODO: Un total de 450 huevos fueron recolectados de diferentes localidades, incluyendo granjas pequeñas (33.3%) y grandes (26.7%), vendedores a la orilla de los caminos (26.7%), y los supermercados (13.3%). Las membranas de la cáscara y yema fueron puestas por separado en un cultivo de agar sangre y agar McConkey. Las Escherichia coli fueron identificadas usando pruebas bioquímicas y tiras API20E. Los aislados fueron sometidos a pruebas para determinar su sensibilidad antimicrobiana. RESULTADOS: Se obtuvo un total de 55 aislados de E coli. De estos, 34 aislados provenían de la membrana de las cáscaras y 21 de las muestras de yemas. Veintidós del total 34 aislados de la membrana, mostraron ser resistentes a uno o más de los antibióticos usados en el estudio, mientras que 11 de los 21 aislados de yemas también mostraron resistencia a uno o más de los antibióticos probados. Entre los seis antibióticos probados, el nivel más alto de resistencia se observó frente a la ampicilina, 42.9 por ciento y 31.8 por ciento respectivamente para la membrana de la cáscara y los aislados de yema. La tasa de resistencia más baja entre todos los antibióticos se observó frente a la enrofloxacina (0%). Una resistencia multidroga (resistencia a > 3 compuestos) se observó en 10.9% de los aislados. CONCLUSIONES: Este estudio sobre la resistencia medicamentosa de E en los huevos comerciales de gallina en Granada, generó datos básicos que indican que los huevos de gallina usados para la alimentación pueden ser fuente de E coli resistentes a los medicamentos. Se garantiza un monitoreo regular de aislados comensales y clínicos de E coli a fin de detectar su resistencia antibacteriana.

Pseudotumor--like presentation of neurobrucellosis.

Brucellosis is bacterial zoonoses. In endemic areas brucellosis can present with clinical features of nearly any neurological illness. Meningitic presentation is most common, with patient presenting with either acute or chronic meningitis. Pseudotumor--like presentation is also documented and accounts for only 4% of cases of neurobrucellosis. Here we are documenting a case of neurobrucellosis with presentation similar to pseudotumor cerebri but with abnormal CSF. This highlights the fact that being a potentially treatable condition brucellosis should always come in the differential diagnosis of neurotuberculosis especially if there are atypical features e.g. pseudotumor presentation with abnormal CSF.

Congestive heart failure in a male with "carcinoma tongue": a case of mistaken identity.

We present a case of primary amyloidosis with macroglossia and restrictive cardiomopathy, that was mistakenly diagnosed as carcinoma of the tongue. He had characteristic echocardiographic findings, and bone marrow plasmacytosis but with normal serum electrophoresis and no Bence Jones proteins in the urine.

Non-Hodgkin's lymphoma of the brainstem with atrial septal mass.

Simultaneous occurrence of cardiac and central nervous system tumors have been rarely reported. A 23 years male presented to us with right cerebello-pontine (CP) angle symptoms and signs. Cranial imaging showed a mass lesion in the right pons infiltrating into the right and middle cerebellar peduncles. There was also a cardiac-atrial septal mass. The brainstem lesion was found to be a non-Hodgkin's lymphoma where as the cardiac lesion was not accessible. Central nervous system lymphomas are reported rarely and the prognosis is poor. The chances of the cardiac lesion in this patient also being a lymphoma are high, as it was a infiltrative cardiac mass, infiltrating the atrial septum.

Gallbladder disorders and type 2 diabetes mellitus--a clinic-based study.

AIMS OF THE STUDY: To study the prevalence of gallbladder disorders in type 2 diabetic patients and their correlation with patient factors like age, sex, weight, duration of diabetes and autonomic neuropathy. METHODOLOGY: Fifty type 2 diabetic patients and 30 healthy controls underwent realtime ultrasonography to study the prevalence of gallbladder disorders. The fasting gallbladder volume and contraction 60 minutes after a fatty meal of the diabetic subjects were compared with 30 age and sex matched healthy volunteers. The age, sex, weight, duration of diabetes, autonomic neuropathy, control of diabetes were correlated to the prevalence of gallbladder disorders in diabetic patients. RESULTS: 32% of the diabetic patients had ultrasonographic evidence of gallstones, as compared to 6.7% in healthy subjects. 73.7% of the diabetic patients with gallbladder disorders were females. Mean fasting gallbladder volume was significantly increased in diabetic patients (26.2 cm3) as compared to non-diabetic healthy subjects (15.8 cm3). Further mean fasting gallbladder volume of diabetic patients with gallbladder disorder (28.1 cm3) was found to be significantly larger than that of those patients without gallbladder disorder (24.6 cm3). Mean percentage of contractions of gallbladder 60 min after fatty meal was reduced in diabetic patients (53.1%) and it was observed to be further reduced in the patients with gallbladder disorder (41.8%). Mean fasting gallbladder volume was larger in diabetic subjects with autonomic neuropathy, than those without. However, difference in mean percentage contraction of gallbladder 60 min after fatty meal was not statistically significant. Mean duration of diabetes was significantly longer in diabetic patients with gallbladder disorder. CONCLUSIONS: We conclude that type 2 diabetic patients have increased prevalence of gallbladder disorder which can only partially be explained by autonomic neuropathy leading, to increased fasting volume. Factors like decreased cholecystokinin or decreased sensitivity of the smooth muscle of gallbladder to normal level of cholecystokinin need to be studied.

Ankle brachial index as a predictor of generalized atherosclerosis.

OBJECTIVE: To assess ankle brachial index (ABI) as a screening method to target subclinical atherosclerosis in middle aged individuals. MATERIAL AND METHODS: Total 160 patients over the age of 40 years were included in the study for a period of 16 months. Their ABI was determined either by colour Doppler method (30 patients) and/or sphygmomanometry (all 160 patients). A value of < 0.9 was taken as cutoff point for significant stenosis. RESULTS: Total 69 patients out of total of 160 had significantly low ABI value (43.12%) which shows that there is a very high incidence of low ABI in the community. Overall > 50% of the patients were largely asymptomatic and had presence of two or more risk factors. ABI < 0.9 was a good screening test to detect such individuals at an earlier stage (sub-clinical). CONCLUSION: A significantly low (< 0.9) ABI value can detect subclinical atherosclerotic vascular involvement and predict future occurrence of preventable major vascular event.